Establishment of an interdisciplinary board for bone and joint infections

Abstract

Purpose: The incidence of bone and joint infections is increasing while their treatment remains a challenge. Although guidelines and recommendations exist, evidence is often lacking and treatment complicated by complex clinical presentations and therapeutic options. Interdisciplinary boards shown to improve management of other diseases, seem potentially helpful. We describe the establishment of an osteomyelitis board to show the existing demand for such a platform.

Methods: All patients discussed in the board for bone and joint infections between October 2014 and September 2020 were included in this retrospective study. Data were extracted from patient records and analyzed descriptively.

Results: A total of 851 requests related to 563 patients were discussed in the board during the study period. After a run-in period of 3 years, a stable number of cases (> 170/year) were discussed, submitted by nearly all hospital departments (22 of 25). Recommendations were mainly related to antibiotic treatment (43%) and to diagnostics (24%). Periprosthetic joint infections were the most frequent entity (33%), followed by native vertebral osteomyelitis and other osteomyelitis. In 3% of requests, suspected infection could be excluded, in 7% further diagnostics were recommended to confirm or rule out infection.

Conclusions: A multidisciplinary board for bone and joint infections was successfully established, potentially serving as a template for further boards. Recommendations were mainly related to antibiotic treatment and further diagnostics, highlighting the need for interdisciplinary discussion to individualize and optimize treatment plans based on guidelines. Further research in needed to evaluate impact on morbidity, mortality and costs.

Keywords: Bone and joint infection; Foreign material-associated infection; Interdisciplinary board; Osteomyelitis; Periprosthetic joint infection; Vertebral osteomyelitis.

Fig. 1

Development of the number of departments enrolling patients in the OMB (OMB osteomyelitis board). In the last year, cases were submitted by 22 of 25 departments involved in patient care at our university hospital

Fig. 2

Development of requests for the OMB over the years (OMB osteomyelitis board). A continuous increase can be seen up to stable-high numbers of about 170 cases/year

Fig. 3

Classification of the 706 bone- and joint-associated infections discussed at the OMB (OMB osteomyelitis board). Periprosthetic infections were counted as a separate entity, infections associated with internal plate and/or screw fixation were subsumed under "foreign material-associated infections"